Objectives: This study set out to profile the diagnoses and level of suicidal behaviour of adolescents aged 12-15 years newly referred to a Child and Adolescent Mental Health Service (CAMHS). Information on the nature and range of disorders and level of functional impairment among adolescents attending outpatient CAMHS is important for service planning and development.

Methods: A total of 100 newly referred adolescents were assessed using the KSADS-PL standardised interview. Overall level of functional impairment was measured using The Clinical Global Impressions Scale and The Children's Global Assessment Scale.

Results: Results showed that the majority of adolescents had more than one disorder, with almost one quarter having four or more disorders. Behavioural disorders were the most common diagnostic category, followed by anxiety disorders, and affective disorders. Although relatively uncommon, levels of functional impairment were highest in those with psychotic disorders, followed by substance abuse disorders. The most common pattern of comorbid disorders were depressive disorders plus anxiety disorders, followed by anxiety disorders plus behavioural disorders and depressive disorders plus behavioural disorders. One quarter of the young people had engaged in suicidal acts in the six months prior to attendance, while this had been the case in over one half of those with a depressive disorder.

Conclusion: This study showed that adolescents attending CAMHS tend to have multiple disorders, high levels of suicidality, and are significantly functionally impaired. These factors need to be taken into account in the development of effective treatments.

Objectives: This study (a) describes the clinical and demographic profile of urban to rural migrants attending a psychiatric outpatient clinic and (b) explores the impact of the move on patients' mental health and lifestyle.

Methods: A self-rated questionnaire distributed to 207 consecutive outpatients requested demographic and clinical information from migrant and non-migrant patients. A focus group study among a purposeful sample of 10 migrant patients explored participants perceptions of the move and its impact on mental health.

Results: One hundred and one patients (48.8%) returned the questionnaire. Most migrant responders described housing affordability as influencing their decision and were generally satisfied with the move. However, half reported reduced access to social amenities. Over half of the migrant outpatients had a previous psychiatric history and were mostly unemployed despite being home-owners. Predominant focus group themes included the perceived need to leave the city for the relative safety and calm of rural living as well as post-migration concerns regarding future isolation and diminished levels of support.

Conclusion: Clinicians and service providers in rural areas should be informed by an awareness of the potential mental health implications of counter-urbanisation.

Objectives: This study assessed patients' views of a methadone programme in a Dublin general practice including the degree to which the patients were ‘involved in decisions about their treatment’.

Method: All patients receiving methadone were asked to participate. A face to face questionnaire, with open and closed questions, was administered. Interviews lasted approximately 30 minutes. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using a thematic approach.

Results: Forty one (87%) of the 47 patients attending the general practice methadone service were interviewed. Of the 39 patients who had used heroin on admission, 69% had stopped and 31% reduced heroin use since starting methadone treatment. A total of 71% reported that the doctor either always involved (59%) or sometimes involved (12%) them in decisions about their treatment. Involvement was interpreted as ‘being listened to’ or ‘having a say’ in deciding methadone dose. Surprisingly those who reported that they were not involved in treatment decisions were more likely to have stopped heroin use (10/11). A significant majority of patients (81%) expressed the desire to stop taking methadone.

Conclusion: Most patients receiving methadone in general practice were listened to and had a say in deciding their methadone dose but did not have an opportunity to engage in more structured or contractual forms of involvement in treatment such as written care plans. In line with a patient centred approach, treatment providers should set their sights beyond the safe delivery of methadone, to provide a service which is centred on patient goals, expectations and choice.

Objectives: This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication.

Methods: A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months.

Results: A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, ‘changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00.

Conclusion: A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.

Objectives: Primary care teams have the potential to deliver much of the care currently provided by specialist services. The aim of this review was to determine from patients' clinical records and multidisciplinary team discussions, those that may be suitable for discharge back into primary care.

Methods: A retrospective review of the clinical notes of all patients attending a psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to determine the appropriateness of continuing to provide psychiatric services in a specialised psychiatric clinic rather than in a primary care setting, taking into account the patients demographic and clinical variables.

Results: It was recommended that 60% of all the patients needed to continue attending the local mental health service, 35.2% could be discharged back into primary care for continuing management whilst the remaining 4.8% could be managed jointly between primary care and the community mental health service. The bulk of the patients recommended for discharge into primary care had a diagnosis of anxiety disorder or depression and all of them had been stable on their treatment for more than six months.

Conclusion: Regular multidisciplinary team review has a potential to identify patients who could be discharged back into primary care.

Objectives: This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.

Method: Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.

Results: One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.

Conclusions: There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.

Objectives: Cognitive stimulation therapy (CST) has been shown to produce improvements in cognition and quality of life which compare favourably with trials of cholinesterase inhibitors. The aim of the present study was to evaluate the efficacy of CST, replicating the methods of Spector et al in the British Journal of Psychiatry in 2003 in a smaller sample using a control group engaged in routine activities.

Methods: Eligible participants (mild to moderate dementia; MMSE range 10-23) were randomised to CST group or control conditions. Pre- and post-intervention testing was undertaken by assessors who were blind to condition. Measures included MMSE, CDR (sum of boxes), ADAS-cog, RAID (anxiety), abbreviated GDS (depression), QoL-AD, and the CAPE Behaviour Rating Scale (BRS). Analysis was by non-parametric statistics. Occupational therapists facilitated two sessions per week for seven weeks in two long-term care facilities and the same programme was run by the activity co-ordinator in a nursing home unit.

Results: Fourteen CST and 13 control participants completed the study. Between group difference scores analysis showed that the CST group improved compared to controls on MMSE (Mann-Whitney U = 32, p = 0.013) and on the QoL-AD which just fell short of significant (U=51.5, p = 0.055). Qualitatively, therapists noted that CST participants demonstrated good interaction and enthusiasm in the group environment, with continuity and carryover between sessions.

Conclusions: Even though the sample sizes are small the current study is consistent with the Spector et al's findings in 2003 of beneficial effects in people with dementia following CST. The programme is recommended as an intervention for people with mild to moderate dementia.

Objective: To examine the rate of cognitive decline and occurrence of dementia among patients attending a lithium clinic for those aged 65 years and over.

Method: Retrospective chart review of the cognitive function of 29 patients receiving maintenance lithium treatment attending the Dublin South East Old Age Psychiatry service, over a nine-year time period.

Results: Twenty-nine patients were included in the study (20 female, nine males), with a mean age of 79 years. Two patients had concurrent dementia. Six patients fulfilled ICD10 criteria for mild cognitive disorder and all of these patients also fulfilled revised consensus criteria for mild cognitive impairment amnestic subtype. Sixteen patients were commenced on lithium as an augmentation treatment for recurrent depressive disorder, 12 patients were on treatment for bipolar affective disorder and one patient on treatment for schizoaffective disorder. Patients had been receiving lithium treatment for an average of 109 months with follow-up by the service for a mean duration of 38 months. The initial mean MMSE score of patients at first presentation to the service was 26.9 (SD = 5.6) compared to a mean MMSE score 25.8 (SD = 5.8) (CI of change in MMSE score at 95% level = −2.1 and 0) at follow-up. The mean MMSE of patients with mild cognitive impairment prior at first contact with the service was 26.8 (SD = 3.2) and at follow-up was 26 (SD = 3.2) which was not statistically significantly different (p=0.40) (CI for change in MMSE at 95% level = −3.2 to 1.5). No patient had developed incident dementia during the follow-up period of the study.

Conclusion: The results tentatively suggest that lithium may have a protective effect against cognitive decline and a neuroprotective role in patients with concurrent affective disorder and cognitive impairment. Multi-centre prospective studies of cognitive function in patients attending lithium clinics are needed to examine the neuroprotective properties of lithium.

Objectives: Neuroimaging is being used increasingly in the investigation of psychiatric disorders. Previous studies have found abnormalities in about two-thirds of all scans done in psychiatry. The aim of our study was to investigate the use of CT and MRI in the management of inpatients in psychiatry department Adelaide & Meath hospital, Tallaght and to examine the relationship between diagnosis and abnormalities seen on scans.

Method: We did a two-year retrospective study of all inpatient referrals for CT scans/MRI scans. A case note review of bio-demographic data, diagnosis, relevant medical history, substance misuse history, indication for tests and results of scans was done. We found that 66 CTs and MRI scans were done over the study period.

Results: Fourteen (21%) of the scans had abnormal results which were mostly atrophic changes. Of the 14 abnormal scans, seven had abnormal findings on neurological examination. We found a lower number of abnormal scans compared to previous studies.

Conclusions: Radiological abnormalities were not disease specific. We wish to propose guidelines on the indications for using neuroimaging in psychiatric patients.

Objectives: Although epilepsy and psychiatric disorder are known to be associated, little is known about the nature of epilepsy in psychiatric inpatients and how well psychiatrists manage psychiatric patients with epilepsy. The aim of this study was to describe the nature of epilepsy in patients at a large specialist independent psychiatric hospital and to audit the management of epilepsy using patients' records.

Method: Cross-sectional survey of inpatients and audit of clinical documents. Audit standards were derived from good clinical practice and UK guidelines.

Results: In total, 83/488 (17%) patients had a life-time history of epileptic seizures and 67 (14%) were receiving anti-epileptic drugs. The prevalence of epilepsy was 37% among brain injury patients, compared with 10-11% in adult male and female forensic patients and in the elderly and 2% in adolescents. Generalised tonic-clonic seizures predominated. Common aetiological factors were: traumatic brain injury, antipsychotics, cerebral hypoxia, cerebrovascular disease and learning disability. In 53/67 (79%) cases the care plan stated the patient had epilepsy but in only 20 (30%) was the seizure type recorded. For 30 (45%) there was no history of how epilepsy had been diagnosed. Of those patients with a history of status epilepticus, 5/15 (33%) had a readily accessible emergency treatment plan. The patient's last seizure was incompletely documented in 29/44 (66%) cases, while for only 7/67 (10%) patients was there documented evidence of a review of epilepsy management within the past year.

Conclusions: Epilepsy was common in this group of psychiatric inpatients. Documentation and management needed improvement and to be in line with national guidelines.

The concept of recovery entered the lexicon of the mental health services in the 1980s following the publication of a series of studies and personal narratives which demonstrated that the course of mental illness was not always one of inevitable deterioration and that people diagnosed with severe mental illness could reclaim or recover meaningful lives. For a long time, recovery was not thought possible by many family members, service providers and researchers. However globally, specific policy and clinical strategies are being developed to implement recovery principles although key questions remain. In fact, the possibility of recovery is still debated by some. In this paper, we include information about the recovery model and the medical model; we provide evidence for recovery and document changes in mental health practices and policies incorporating recovery as the guiding principle. We also attempt to address the debate as to whether recovery is an evidence based practice. We propose that evidence based practice should be complementary to value-based and narrative-based practices and we suggest an integrative model that maximises the virtues and minimises the weaknesses of each practices (see Figure 1).

Sexual dysfunction (SD) is widely recognised as a potential side-effect of antidepressant therapy. SD has been reported with all classes of antidepressants (MAOIs, TCAs, SSRIs, SNRIs and newer antidepressants) in patients with depression and anxiety disorders. Increased attention has been directed at the SD produced by antidepressants; not only because its initial prevalence was underestimated but also because of the adverse impact that these side-effects can have on treatment compliance. Although SD is an important adverse effect of antidepressant medication, patients tend to be reluctant to report them if not directly questioned. This suggests that consideration of the doctor-patient relationship is needed when deciding on an appropriate treatment plan.

We describe here the case of a 45-year-old man with a chronic history of heroin abuse who has received methadone maintenance therapy for 12 years. At admission, on this occasion, for stabilisation on methadone, he reported a two-year history of painful gynaecomastia and testicular atrophy. Investigations revealed abnormal sex hormone levels. Liver function tests, thyroid function tests, Brain (pituitary) MRI and viral screens were normal. Following assessment and abnormality in two morning total testosterone level measurements he was diagnosed with hypogonadism secondary to opioid use. Although he had a previous history of alcohol abuse, he was abstinent from alcohol use for five years at time of assessment. He was commenced on parenteral testosterone replacement with therapeutic benefit.

In light of the increased use of opioids, it is important to recognise and manage the endocrine complications of opioid use. The need for an empathic and adequate sexual history, physical examination and investigation is essential in patients who use opioids to ensure that cases of hormonal dysfunction are detected early and managed appropriately.

Neuropsychiatric sequelae in patients with epilepsy have been vastly studied and documented. These may be affective, cognitive or psychotic. Certain risk factors may predispose some epileptics more to these sequelae. In general, good epileptic control may minimize these outcomes. We present in this report, a case of postictal psychosis (PIP), superimposed on delirium, in a 68-year-old woman, with history of a single previous psychotic illness following a cluster of seizures. This report shows a collaborative management of the neuropsychiatric complications of temporal lobe epilepsy (TLE), by the neurology, geriatric medicine and psychiatry teams.